ICU ward design and nosocomial infection rates: a cross-sectional study in Germany.

BACKGROUND: There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. OBJECTIVE: To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates. METHODS: In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015. FINDINGS: In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2 (interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86). CONCLUSION: Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.

Urethral plugs in dogs.

BACKGROUND: Crystalline-matrix urethral plugs have not been previously reported in dogs. HYPOTHESIS/OBJECTIVES: To report the composition of urethral plugs in dogs, describe clinical features of the disease, and identify overrepresented breeds. METHODS: Retrospective case series. A Minnesota Urolith Center (MUC) record search was performed for urethral plugs in dogs submitted during a 6-year period. The composition of the plugs and signalment of affected dogs were recorded. Breed risk analysis was performed using a control group without plugs from the Veterinary Medical Center, University of Minnesota (VMC UMN). Breed risk was also calculated for a group of dogs with struvite (plugs and uroliths). Medical records for the subset of plug cases from the VMC UMN were reviewed and described. RESULTS: Between 2006 and 2011, 42 urethral plugs from dogs were submitted to the MUC. All came from male dogs, and the mineral component of the majority (83%) was struvite. Thirty (71%) samples were from Pugs. Pugs were overrepresented in plug submissions (OR 179; CI 88-389; P < .001), and for struvite in general (OR 14.3; CI 7.9-24.4; P < .001). Nine of the dogs were treated at VMC UMN; all were castrated male Pugs. None of these cases had bacteriuria or positive urine cultures, and no underlying cause of plug formation was identified. CONCLUSIONS AND CLINICAL IMPORTANCE: When evaluating dogs with urethral obstruction, plugs need to be considered, especially in male Pugs. Further investigation into the underlying cause of plug formation in dogs is warranted.

Deuteron breakup in the 2H(e,e' p) reaction at low momentum transfer and close to threshold.

Deuteron breakup has been studied in a 2H(e,e' p) coincidence experiment at low momentum transfer and for energies close to threshold. The longitudinal-plus-transverse ( L+T) and longitudinal-transverse ( LT) interference cross sections are deduced. Nonrelativistic calculations based on the Bonn potential and including leading order relativistic contributions, meson exchange currents, and isobar configurations describe the ( L+T) data well. Surprisingly, large deviations of 30% to 45% are observed for the LT contribution.

Case management: implementing the vision.

Case management is a strategy for restructuring the health care delivery system. The system requires critical planning and implementation steps to achieve quality care at reduced cost.

Characterization of cytochrome P4501A induction in medaka (Oryzias latipes) by samples generated from the extraction and processing of coal.

The objective of this study was to characterize cytochrome P4501A induction in medaka liver as a biomarker for detecting polyaromatic hydrocarbon (PAH)-type compounds in samples of processed coal or petroleum. Ethoxyresorufin-O-deethylase (EROD) activity in individual medaka livers was used to asses induction of P4501A following the addition of various samples to aquaria water. Samples included a known P4501A inducer, beta-naphthoflavone, and various processed coal samples, as well as a petroleum-pitch. The sensitivity of detecting significant EROD induction by adding samples to aquaria water was approximately 0.1 mg/L for most samples; however, a coal-tar pitch significantly increased EROD activity at 0.01 mg/L. Different samples induced EROD activity to different extents. All samples elicited a concentration-dependent increase in EROD activity, with maximum EROD induction 2 days after a single administration of xenobiotics to aquaria water. Western blot studies established that induction of EROD activity by all xenobiotics tested was associated with corresponding increased amounts of immunoreactive P4501A. EROD induction was not influenced by gender, by single or multiple xenobiotic exposures, nor by feeding or fasting animals during the course of xenobiotic exposure. The ability of xenobiotics to induce EROD activity in medaka liver did not always correlate with their genotoxic potential determined by bacterial mutagenesis assays. Induction of P4501A in medaka liver appears to provide a convenient, economical, reliable and sensitive indicator for the presence of PAH-type compounds in coal- or petroleum-derived samples.

Placental chorioangioma: a rare cause of fetomaternal transfusion with maternal hemolysis and fetal distress.

Multiple placental chorioangiomas in a 31-year-old woman led to a severe, acute fetal-to-maternal transfusion and maternal hemoglobinuria from hemolysis of the fetal red blood cells. Fetal distress was manifest by a sine wave fetal monitor pattern. A severely asphyxiated infant was delivered by cesarean section. The infant did well after transfusion therapy.

No elevation of the frequencies of chromosomal alterations as a consequence of handling cytostatic drugs. Analyses with peripheral blood and urine of hospital personnel.

Peripheral blood lymphocytes of hospital personnel handling cytostatic drugs showed no elevation of structural chromosomal aberrations or sister-chromatid exchanges (SCE) over the baseline. The urine of the probands did not induce SCE in peripheral lymphocytes in vitro.

Mutagens in human urine: test with human peripheral lymphocytes.

A test is described in which human peripheral blood is enclosed in dialysis bags and exposed to human urine. After the treatment, the blood is cultivated in the presence of bromodeoxyuridine, and metaphases are analyzed with respect to the frequencies of sister-chromatid exchanges (SCE). Urine from clinically healthy people and from epileptic patients on therapy with anti-epileptic drugs did not lead to an elevation of SCE frequencies. Urine from cancer patients treated with a multi-drug combination therapy including cyclophosphamide led to a significant increase in the frequencies of SCEs.